动态对比增强3T磁共振成像与64排多层螺旋CT血管造影术在脊髓硬脊膜动静脉瘘定位中的比较
Comparison of dynamic contrast-enhanced 3T MR and 64-row multidetector CT angiography for the localization of spinal dural arteriovenous fistulas.
作者信息
Oda S, Utsunomiya D, Hirai T, Kai Y, Ohmori Y, Shigematsu Y, Iryo Y, Uetani H, Azuma M, Yamashita Y
机构信息
From the Departments of Diagnostic Radiology (S.O., D.U., T.H., Y.S., Y.I., H.U., M.A., Y.Y.).
出版信息
AJNR Am J Neuroradiol. 2014 Feb;35(2):407-12. doi: 10.3174/ajnr.A3660. Epub 2013 Aug 1.
BACKGROUND AND PURPOSE
For the localization of spinal dural arteriovenous fistulas, it is not determined whether dynamic contrast-enhanced MRA is more reliable than multidetector CTA. The aim of this study was to compare the agreement between intra-arterial DSA, dynamic contrast-enhanced MRA at 3T, and 64-row multidetector CTA for the localization of spinal dural arteriovenous fistulas.
MATERIALS AND METHODS
We enrolled 12 consecutive patients (11 men, 1 woman; age range, 46-83 years; mean, 65 years) who underwent preoperative dynamic contrast-enhanced MRA at 3T and 64-row multidetector CTA. The spinal dural arteriovenous fistula location was confirmed by intra-arterial DSA as the reference standard. Two reviewers independently evaluated the level of the artery feeding the spinal dural arteriovenous fistula on the basis of continuity between the feeder and abnormal spinal vessels on 3T dynamic contrast-enhanced MRA and 64-row multidetector CTA images. Interobserver and intermodality agreement was determined by calculation of the κ coefficient.
RESULTS
On DSA, the vessel feeding the spinal dural arteriovenous fistula was the intercostal artery (7 cases), the lumbar artery (3 cases), and the internal iliac artery or the ascending pharyngeal artery (1 case each). For the fistula level, interobserver agreement was excellent for 3T dynamic contrast-enhanced MRA (κ = 0.97; 95% CI, 0.92-1.00) and very good for 64-row multidetector CTA (κ = 0.84; 95% CI, 0.72-0.96). Intermodality agreement with DSA was good for 3T dynamic contrast-enhanced MRA (κ = 0.78; 95% CI, 0.49-1.00) and moderate for 64-row multidetector CTA (κ = 0.41; 95% CI, 0.020-0.84).
CONCLUSIONS
For the localization of spinal dural arteriovenous fistulas, 3T dynamic contrast-enhanced MRA may be more reliable than 64-row multidetector CTA.
背景与目的
对于脊髓硬脊膜动静脉瘘的定位，目前尚不确定动态对比增强磁共振血管造影（MRA）是否比多排CT血管造影（CTA）更可靠。本研究的目的是比较动脉内数字减影血管造影（DSA）、3T动态对比增强MRA和64排多排CTA在脊髓硬脊膜动静脉瘘定位方面的一致性。
材料与方法
我们纳入了12例连续患者（11例男性，1例女性；年龄范围46 - 83岁，平均65岁），这些患者均接受了术前3T动态对比增强MRA和64排多排CTA检查。以动脉内DSA确定的脊髓硬脊膜动静脉瘘位置作为参考标准。两名阅片者根据3T动态对比增强MRA和64排多排CTA图像上供血动脉与异常脊髓血管之间的连续性，独立评估脊髓硬脊膜动静脉瘘供血动脉的水平。通过计算κ系数来确定观察者间和不同检查方法间的一致性。
结果
在DSA上，为脊髓硬脊膜动静脉瘘供血的血管为肋间动脉（7例）、腰动脉（3例）以及髂内动脉或咽升动脉（各1例）。对于瘘的水平，观察者间一致性在3T动态对比增强MRA方面为优（κ = 0.97；95%可信区间，0.92 - 1.00），在64排多排CTA方面为良（κ = 0.84；95%可信区间，0.72 - 0.96）。与DSA的不同检查方法间一致性在3T动态对比增强MRA方面为良（κ = 0.78；95%可信区间，0.49 - 1.00），在64排多排CTA方面为中等（κ = 0.41；95%可信区间，0.020 - 0.84）。
结论
对于脊髓硬脊膜动静脉瘘的定位，3T动态对比增强MRA可能比64排多排CTA更可靠。
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